CMS Modifies PMD Demonstration, Sets New Date

The Centers for Medicare & Medicaid Services (CMS) announced in early February that it will initiate the Prior Authorization of Power Mobility Devices (PMDs) Demonstration Program “on or after” June 1, 2012. The demonstration will implement a prior authorization process for scooters and power wheelchairs, “to help ensure that a beneficiary’s medical condition warrants their medical equipment under existing coverage guidelines.”

The PMD demonstration had been scheduled to begin Jan. 1, 2012, but was delayed because of feedback CMS had received from providers and suppliers affected by the program. In response to concerns from those parties, CMS has made two important modifications to the program:

  1. There will be no prepayment review phase of the demonstration project, as initially proposed in November 2011. CMS will go directly to the prior authorization phase.
  2. CMS will allow PMD providers to submit prior authorization requests on behalf of physicians.

The Prior Authorization of PMDs Demonstration Program will be initiated in California, Illinois, Michigan, New York, North Carolina, Florida, and Texas. These states have been targeted due to high populations of fraud- and error-prone providers.

For more information, see the Prior Authorization of Devices (PMDs) Demonstration Fact Sheet.


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One Response to “CMS Modifies PMD Demonstration, Sets New Date”

  1. Connie says:

    So if it’s just to be a prior auth, and the PMD providers can submit it on behalf of physicians, and it’s just to make sure their condition warrants the equipment based on current guidelines – how is this info going to differ from what’s being submitted on claims now? It’s going to come from the same people for the same purpose, and they presumably know what gets it covered under current guidelines. I don’t see how this is going to weed out fraud. And I must say I can’t listen to those commercials about how they all get their deluxe equipment for “free” while being told that all the money I’ve paid in for 40 yrs will be gone before I draw a cent of it. I don’t doubt there’s fraud to be weeded out, but I don’t see how this watered down demo will help.

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